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OBJECTIVES: The purpose of this study was to assess refracture rates after angulation-only and completely displaced clavicle shaft fractures in children. DESIGN: Retrospective chart review. SETTING: Level 1 pediatric trauma center. PATIENTS: Computerized medical records searches identified children treated nonoperatively for clavicle shaft fractures at our institution. Inclusion criteria were age less than 18 years and a minimum of 1-year radiographic follow-up. Statistical methods included Fisher exact test with significant probability values being defined as less than 0.05. RESULTS: Of the 120 angulation-only patients and 41 completely displaced patients meeting criteria for inclusion in our study, we identified a statistically higher (P = 0.002) refracture rate (18%, 21/120) in angulation-only fractures as compared with 0% (0/41) for completely displaced fractures. Subgroup analysis of the angulation-only fractures revealed that fractures angulated less than 40 degrees refractured at a 26% rate (18/69) versus 6% (3/51) of fractures with greater angulation (P = 0.004). CONCLUSIONS: We found that angulation-only shaft fractures had a significantly higher refracture rate than completely displaced fractures. Furthermore, subgroup analysis demonstrated that less-angulated fractures had a higher refracture rate than the more-angulated ones. We feel this somewhat paradoxical finding is analogous to fractures of the forearm shaft, for which greenstick fractures refracture at a higher rate than complete forearm shaft fractures due to less-exuberant callus formation. LEVEL OF EVIDENCE: Prognostic level III. See instructions for authors for a complete description of levels of evidence.
Masnovi et al. (Wed,) studied this question.